Employment Branch Application

EMPLOYMENT BRANCH APPLICATION

Position and Branch

Branch Location:   Position Applied For:

Department:   Reporting Manager (if known):

Desired Start Date:   Desired Salary or Hourly Rate:

Personal Information

Employment History (Most Recent First)

Job Title:   Dates Employed: From to

Job Title:   Dates Employed: From to

Education

Graduation Date:   Major/Field of Study:

Professional References

Reference 1 — Name:   Phone:

Email:   Relationship:

Reference 2 — Name:   Phone:

Email:   Relationship:

Reference 3 — Name:   Phone:

Email:   Relationship:

Legal Disclosures & Authorizations

At-Will Employment: I acknowledge that, unless otherwise agreed in a written employment agreement signed by an authorized company representative, my employment with the company is at-will. This means either I or the company may terminate the employment relationship at any time, with or without cause or advance notice. Applicant Initials:

Equal Employment Opportunity: The company provides equal employment opportunity to all applicants and employees without regard to protected characteristics. By signing below I certify that I understand and acknowledge this policy.

Authorization to Verify: I authorize the company and its agents to investigate my statements on this application and to obtain information concerning my employment history, education, criminal history, driving record, and other relevant records. I authorize former employers and references to provide information about my work history and character. I release all parties from liability for providing such information. Check to authorize: Yes

Background Check and Drug Testing: I understand that an offer of employment may be conditioned on satisfactory completion of a background check and drug screening where permitted by law. Check to consent: Yes

Eligibility to Work: Are you legally authorized to work in the United States without sponsorship now or in the future?   Yes No

Conviction Disclosure: Have you been convicted of a felony or misdemeanor that could relate to the duties of the position for which you are applying? (Conviction will not necessarily disqualify an applicant.)   Yes No

Applicant Certification and Agreement

I certify that all information provided in this application and any attachments is true, complete, and accurate to the best of my knowledge. I understand that any misstatement, omission, or falsification of information may result in denial of employment, or if employed, immediate termination. I agree to notify the company of any change in the information contained herein.

I agree that the company may retain this application whether or not I am hired. I understand that no representative of the company has the authority to enter into any agreement for employment for any specified period of time unless such agreement is in writing and signed by an authorized company representative.

Signature

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